The Harm in Harm Reduction

by MICHAEL EVERETT

I remember attending the Harm Reduction Coalition (HRC) conference for the first time in 2006, when it was held in Oakland, California. The experience was unlike that of any other conference I had ever attended. I remember being both shocked at how few young people of color were present and yet amazed at the diversity amongst conference goers. While I didn’t witness diversity in terms of race or among youth and adolescents, there was broad representation of active and non-active drug users, HIV prevention specialists, addiction specialists, friends and family of people impacted by drug use, and even members of faith-based communities.

At the time, I was newly employed by a youth organization that had always worked to incorporate harm reduction strategies into their work with young people (which seemed radical then). The Executive Director when I was there believed in exposing staff to harm reduction, as it seemed like a promising tool for addressing issues staff were facing at the drop-in center. To this end, the Director made it a priority to send 17 of her staff members as well as some participants all the way from Philadelphia to Oakland to experience an event that occurs once every two years. The workshops and the people were both fascinating. However, the general agreement amongst staff from my organization was that there were barriers keeping harm reduction and the harm reduction community from being accessible to young people and some per- sons of color. By the time we returned home, we learned that while there are diverse communities across the country (and beyond) practicing harm reduction, it would be necessary to develop different strategies in order to expose harm reduction principles to those who have traditionally been unable to access them.

Beyond that 2006 experience, I continued to attend harm reduction conferences. I also struggled with this idea that I needed to find opportunities to make harm reduction accessible to people who looked like me and had grown up with my experiences. Much like the young people I was working with, I grew up in a household with a Mother who struggled with her own addiction issues. I remember that the only option provided to my Mother was abstinence. For over 20 years, my mother suffered in silence – never feeling quite good enough for her family or the people in our community. I also lived the shame of her addiction; I felt unsupported in my personal decision to meet my mother where she was, while managing my own desires around the person I wanted her to be. We were confined to the limitations of a Narcotics Anonymous culture where cliché’s did not account for individual experiences; I struggled with what I perceived as the Christian-rooted, codependent nature of the program, which was operationalized in both covert and explicit ways.

The 8th National Harm Reduction Conference was held in Austin, Texas during the same year that I came to work for the Harm Reduction Coalition as a Capacity Building Advisor. I’m fortunate that in this role I get to work strategically and concertedly to promote harm reduction as a viable option, particularly for those within the helping profession. The bulk of my work and advocacy experience has been around HIV and I appreciate that capacity building has helped to sustain my interactions with HIV/ AIDS organizations. However, HIV- specific capacity building housed at a harm reduction organization has not only allowed me to expand my understanding of harm reduction from a drug use perspective, but also from an organizational perspective. This has meant offering organizations ways to identify potential harms incurred by an agency’s participants or staff – in addition to public perception of the agency – as a result of its mission and policies.

The “harm reduction for agencies” concept comes from some of the work I have done with organizations that serve Black men who have sex with men (BMSM). It was through my capacity building work that I started to hear employees question certain dynamics, institutions and policies within their organizations, and more broadly, within the field. For example, I heard people exploring things like the impact of all white leadership in institutions that serve BMSM as well as issues that come up when BMSM participants are hired to do outreach in the communities where they live, date and/or frequent. Another taboo topic raised in these conversations — which came out as a common issue at some agencies — is intimate relationships between staff members or between staff and participants. These issues are all potentially harm-initiating factors that could threaten the sustain- ability of organizations and prevent core values from being fully experienced in a positive, empowering way. I recognize that some groups struggle with harm reduction – such as people of color and young people; however perhaps it is because the institution of harm reduction has been inaccessible to them. By inaccessible I mean that despite the fact that people use forms of harm reduction within their everyday lives, the concept of harm reduction has been stigmatized and misrepresented as tool for promoting drug use and the legalization of drugs. The people of color in my community – teachers, young people, politicians, and parents – are often times already stigmatized as drug users because of what they look like or where they live and have, therefore, worked hard to be disassociated with any perceived promotion of drug use. In addition, I think that harm reduction has meant different things to different people; in turn, messaging consistency has become complicated and resulted in rejection from populations who could benefit from it.

Exploring new strategies

I spent the last six years thinking about what my contribution to harm reduction could be, and it was at the 2011 conference where I was able to actualize that opportunity. I worked with a colleague at HRC to develop and present a workshop entitled, “Different People Common Ground: The intersections of Human Relations and HIV Prevention”. The workshop deconstructed value assumptions and invited conference attendees to examine service provision through the lens of oppression. This workshop challenged participants to process change through the ecological model, examining the implications of the social environment while also being empowered by the impact an individual can make on society. The ecological model is rooted in domestic violence prevention. It draws on systems theory to dissect social systems to more clearly identify what promotes and sustains problems on the individual, interpersonal/relationship, community and societal levels. For example – let’s assume an agency has recently hired a participant to provide outreach services. Let’s also assume that the employee was subsequently reprimanded a few times for engaging in “inappropriate” behavior with other participants during outreach hours. The ecological model may be a useful tool for this organization to gain a broad yet specific perspective of the issue (see figure).

From the individual perspective – thinking about what is going on internally – the employee might indicate that knowing everyone in the neighborhood makes it difficult for her to engage professionally. The employee might feel that it is not a “big deal” because these people are her friends and her relationship with these people is actually the reason that other participants are more likely to engage in service.

From the relationship perspective, it’s possible that the employee is feeling pressure to engage in familiar behaviors, and to be the “same person” amongst her friends that she was before she was hired by the agency. This tension can complicate things.

The community area of influence asks us to question the culture or climate within an organization that might promote or perpetuate certain behaviors or interpersonal dynamics. Continuing the example above, the community perspective may look for contradictions or inconsistencies in policy that could have had an impact on the situation. Perhaps the agency tolerates informal relationships to a degree – such as a program manager and program staff person who are best friends or even a staff member and a participant who are roommates. The newly hired outreach worker may be confused by these different boundaries, recognizing that, to some degree, there is a relationship beyond a professional one. Agency tolerance of the other relationships (for whatever reasons) may lead the outreach worker to feel that she can also navigate the professional and familiar roles with agency participants. Lastly we have the societal level, which speaks to the structural forces that create policies and procedures, and that further impact the way an agency exist. For example, policies around employee and participant fraternization are intended to protect the agency from liability. However, most of these policies do not take into account the likelihood that community members who are hired because of their association with a target population may carry a greater burden as a result of such policies than staff that are not. This could result in heightened frustration among outreach workers primarily because a great deal of their support might come from the community and participants of the organization.

The information within this framework reveals where harm exists beyond a traditional perspective that simply seeks to govern participants. Rather, the analysis also encourages management to revisit ideas around who and how to hire, as well as how to create a working environment that does not ask participants to compromise themselves or their relationships for minimum wage. The ecological model also helps participants in understanding the complexity of potential harms from various perspectives. This means that organizations can be more intentional about the work they do and the people they do it with and for.

The workshop in Austin attracted a broad range of participants from Centers for Disease Control Program Officers to outreach workers and other frontline staff to volunteers, all seeking to make a greater impact within their agency. The workshop focused on leadership development, managing up, internal capacity building and succession planning. Some of the hopes coming out of the workshop were that people will be able to see harm reduction in a different context – a context that promotes harm reduction values and usability beyond its most common association which is injection drug use. It’s important that the general messages around harm reduction and its principles promote values such as empowerment and individualism, while establishing options with people to reduce harm. Lastly, it is equally important that we develop collective values about packaging harm reduction as a philosophy and ensure that these values reflect the complex needs of all people. After all, what good is useful strategy if it is inaccessible to the people who stand to gain the most from it?

Michael T. Everett is the Team Leader for the Harm Reduction Coalition’s Capacity Building Assistance Program. For the past 12 years, Michael has been working in non-profits with various populations most impacted by HIV/ AIDS and other social health issues. Michael holds a Masters degree in Human Services and is currently working on a Doctoral degree in Education.

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One Response to “The Harm in Harm Reduction”

Awesome work! Thank you.
Being somewhat new to the homeless/mental health scene, I have not yet familiar with of much of the industry terminology. I would have benefited from a brief description of “harm reduction” leading into the post.
Thanks Again!
Jared
hopevillagelascruces.wordpress.com